Comparison of flap outcomes between single- and multiple-perforator-based free anterolateral thigh flap in head and neck reconstruction

Kuan Chih Wang, Chia Chin Tsai, Chih Hao Chang, Wan Ling Tseng, Kuo-Shu Hong, Tzu Yen Chang, Szu-Han Chen, Yao-Chou Lee

研究成果: Article

摘要

Introduction: The number of perforators required for safe perfusion remains under debate. This study aimed to determine whether a single- or multiple-perforator-based anterolateral thigh flap yields better flap outcomes in head and neck reconstruction. Patients and Methods: Between August 2012 and July 2016, 180 men and 4 women with a mean age of 52.8 ± 9.8 years underwent head and neck anterolateral thigh flap reconstruction for oncologic defect in 181 cases, plate exposure in two cases, and trismus release in one case. The flap was patched for inner or external lining, folded for through–through defect, or tubed for cervical esophageal reconstruction. Of 184 flaps, 136 (73.9%) were based on multiple perforators (range, 2–5 perforators), whereas 48 (26.1%) were based on a single perforator. The demographics, operative findings, and flap outcomes were compared. Results: The prevalence of systemic diseases between groups was comparable. The mean flap size in the single-perforator group was smaller (92.8 ± 36.8 vs. 140.5 ± 99.9 cm 2 , P <.0001). Twenty-one flaps (11.4%) required emergency take-back and 13 (61.9%) were successfully salvaged. Eight flaps failed, yielding a 95.7% flap survival rate. The single-perforator group had a significantly higher rate of emergency take-back for vascular compromise (8/48 (16.7%) vs. 8/136 (5.9%), P =.035), a decreased salvage success rate (2/8 (25.0%) vs. 11/13 (84.6%), P =.018), and a corresponding lower flap survival rate (42/48 (87.5%) vs. 134/136 (98.5%), P =.004). Conclusion: Whenever possible, we recommend including multiple cutaneous perforators in anterolateral thigh flaps to yield better flap outcomes in head and neck reconstruction.

原文English
頁(從 - 到)150-155
頁數6
期刊Microsurgery
39
發行號2
DOIs
出版狀態Published - 2019 二月 1

指紋

Thigh
Neck
Head
Emergencies
Survival Rate
Trismus
Blood Vessels
Perfusion
Demography
Skin

All Science Journal Classification (ASJC) codes

  • Surgery

引用此文

Wang, Kuan Chih ; Tsai, Chia Chin ; Chang, Chih Hao ; Tseng, Wan Ling ; Hong, Kuo-Shu ; Chang, Tzu Yen ; Chen, Szu-Han ; Lee, Yao-Chou. / Comparison of flap outcomes between single- and multiple-perforator-based free anterolateral thigh flap in head and neck reconstruction. 於: Microsurgery. 2019 ; 卷 39, 編號 2. 頁 150-155.
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title = "Comparison of flap outcomes between single- and multiple-perforator-based free anterolateral thigh flap in head and neck reconstruction",
abstract = "Introduction: The number of perforators required for safe perfusion remains under debate. This study aimed to determine whether a single- or multiple-perforator-based anterolateral thigh flap yields better flap outcomes in head and neck reconstruction. Patients and Methods: Between August 2012 and July 2016, 180 men and 4 women with a mean age of 52.8 ± 9.8 years underwent head and neck anterolateral thigh flap reconstruction for oncologic defect in 181 cases, plate exposure in two cases, and trismus release in one case. The flap was patched for inner or external lining, folded for through–through defect, or tubed for cervical esophageal reconstruction. Of 184 flaps, 136 (73.9{\%}) were based on multiple perforators (range, 2–5 perforators), whereas 48 (26.1{\%}) were based on a single perforator. The demographics, operative findings, and flap outcomes were compared. Results: The prevalence of systemic diseases between groups was comparable. The mean flap size in the single-perforator group was smaller (92.8 ± 36.8 vs. 140.5 ± 99.9 cm 2 , P <.0001). Twenty-one flaps (11.4{\%}) required emergency take-back and 13 (61.9{\%}) were successfully salvaged. Eight flaps failed, yielding a 95.7{\%} flap survival rate. The single-perforator group had a significantly higher rate of emergency take-back for vascular compromise (8/48 (16.7{\%}) vs. 8/136 (5.9{\%}), P =.035), a decreased salvage success rate (2/8 (25.0{\%}) vs. 11/13 (84.6{\%}), P =.018), and a corresponding lower flap survival rate (42/48 (87.5{\%}) vs. 134/136 (98.5{\%}), P =.004). Conclusion: Whenever possible, we recommend including multiple cutaneous perforators in anterolateral thigh flaps to yield better flap outcomes in head and neck reconstruction.",
author = "Wang, {Kuan Chih} and Tsai, {Chia Chin} and Chang, {Chih Hao} and Tseng, {Wan Ling} and Kuo-Shu Hong and Chang, {Tzu Yen} and Szu-Han Chen and Yao-Chou Lee",
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Comparison of flap outcomes between single- and multiple-perforator-based free anterolateral thigh flap in head and neck reconstruction. / Wang, Kuan Chih; Tsai, Chia Chin; Chang, Chih Hao; Tseng, Wan Ling; Hong, Kuo-Shu; Chang, Tzu Yen; Chen, Szu-Han; Lee, Yao-Chou.

於: Microsurgery, 卷 39, 編號 2, 01.02.2019, p. 150-155.

研究成果: Article

TY - JOUR

T1 - Comparison of flap outcomes between single- and multiple-perforator-based free anterolateral thigh flap in head and neck reconstruction

AU - Wang, Kuan Chih

AU - Tsai, Chia Chin

AU - Chang, Chih Hao

AU - Tseng, Wan Ling

AU - Hong, Kuo-Shu

AU - Chang, Tzu Yen

AU - Chen, Szu-Han

AU - Lee, Yao-Chou

PY - 2019/2/1

Y1 - 2019/2/1

N2 - Introduction: The number of perforators required for safe perfusion remains under debate. This study aimed to determine whether a single- or multiple-perforator-based anterolateral thigh flap yields better flap outcomes in head and neck reconstruction. Patients and Methods: Between August 2012 and July 2016, 180 men and 4 women with a mean age of 52.8 ± 9.8 years underwent head and neck anterolateral thigh flap reconstruction for oncologic defect in 181 cases, plate exposure in two cases, and trismus release in one case. The flap was patched for inner or external lining, folded for through–through defect, or tubed for cervical esophageal reconstruction. Of 184 flaps, 136 (73.9%) were based on multiple perforators (range, 2–5 perforators), whereas 48 (26.1%) were based on a single perforator. The demographics, operative findings, and flap outcomes were compared. Results: The prevalence of systemic diseases between groups was comparable. The mean flap size in the single-perforator group was smaller (92.8 ± 36.8 vs. 140.5 ± 99.9 cm 2 , P <.0001). Twenty-one flaps (11.4%) required emergency take-back and 13 (61.9%) were successfully salvaged. Eight flaps failed, yielding a 95.7% flap survival rate. The single-perforator group had a significantly higher rate of emergency take-back for vascular compromise (8/48 (16.7%) vs. 8/136 (5.9%), P =.035), a decreased salvage success rate (2/8 (25.0%) vs. 11/13 (84.6%), P =.018), and a corresponding lower flap survival rate (42/48 (87.5%) vs. 134/136 (98.5%), P =.004). Conclusion: Whenever possible, we recommend including multiple cutaneous perforators in anterolateral thigh flaps to yield better flap outcomes in head and neck reconstruction.

AB - Introduction: The number of perforators required for safe perfusion remains under debate. This study aimed to determine whether a single- or multiple-perforator-based anterolateral thigh flap yields better flap outcomes in head and neck reconstruction. Patients and Methods: Between August 2012 and July 2016, 180 men and 4 women with a mean age of 52.8 ± 9.8 years underwent head and neck anterolateral thigh flap reconstruction for oncologic defect in 181 cases, plate exposure in two cases, and trismus release in one case. The flap was patched for inner or external lining, folded for through–through defect, or tubed for cervical esophageal reconstruction. Of 184 flaps, 136 (73.9%) were based on multiple perforators (range, 2–5 perforators), whereas 48 (26.1%) were based on a single perforator. The demographics, operative findings, and flap outcomes were compared. Results: The prevalence of systemic diseases between groups was comparable. The mean flap size in the single-perforator group was smaller (92.8 ± 36.8 vs. 140.5 ± 99.9 cm 2 , P <.0001). Twenty-one flaps (11.4%) required emergency take-back and 13 (61.9%) were successfully salvaged. Eight flaps failed, yielding a 95.7% flap survival rate. The single-perforator group had a significantly higher rate of emergency take-back for vascular compromise (8/48 (16.7%) vs. 8/136 (5.9%), P =.035), a decreased salvage success rate (2/8 (25.0%) vs. 11/13 (84.6%), P =.018), and a corresponding lower flap survival rate (42/48 (87.5%) vs. 134/136 (98.5%), P =.004). Conclusion: Whenever possible, we recommend including multiple cutaneous perforators in anterolateral thigh flaps to yield better flap outcomes in head and neck reconstruction.

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